The Family Care Study is a randomized controlled efficacy trial of PREP, and a home health intervention designed to increased Preparedness Enrichment, and Predictability in family care for frail elders. PREP is distinguished by its family focus and has three parts: (1) the family and nurse working together of family care issues, (2) 24-hour PREP Advice Line; and (3) follow-up contact by the nurse using Keep-in-Touch. The abbreviated primary aims (full aims on page 98) are to: (1) describe the care issued identified by PREP families, the strategies implemented to resolve these issues, and the effectiveness of the strategies; (2) determine whether compared to Extended Home Health (EHH) and Standard Home Health (SHH), PREP significantly improves family care variables (e.g., caregiver [CG] skill, CG role strain etc.) And health status, including care receiver (CR) function; (3) determine whether PREP is differentially effective in Black versus White and in low versus middle income families; (4) determine whether EHH, compared to SHH, has beneficial effects on family care variables and health; and (5) determine whether any effects of PREP and EHH on family care variables and health continue after the intervention is withdrawn. The proposed study will also address two secondary aims related to measuring use and cost of formal and informal health care services for CRs and CGs in PREP, EHH, and SHH. The study will use a 3-group design. The sample will include 360 older people who meet Medicare criteria for skilled home care at a large not-for- profit HMO. At least 60 Black and 60 low-income White families will be included in the sample. All samples will be randomized to PREP, EHH, or SHH. PREP will be delivered to families by PREP nurses within the context of an interdisciplinary team for a period of 12 months. In EHH, a home health time comparable in composition to the PREP team will be given the same resources as PREP team will be given the same resources as PREP to deliver care but will not use the goals and principles of PREP. SHH will be the usual home health care provided by the HMO. Six research measures and data sources will be used: The Family Care Inventory, Quality of Family Care Scale, Family Health Diary, KPNW Home Health automated clinical information system (DOCPLUSR), KPNW automated data systems, and the Family Expense Calendar. Utilization and cost data will be obtained for 12 months prior to and 20 months after study entry. Analyses will include regression, survival analysis, and repeated measures ANOVA.